Podcasts about circulationaha

Join our scientific team in the discussion of the 3 most clinically impactful papers of the month, the crème de la crème of our weekly top picks.This month we're discussing:A Randomized Controlled Trial of Thoracentesis in Acute Heart FailureDoi: https://doi.org/10.1161/CIRCULATIONAHA.124.07352Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical TrialDoi: https://doi.org/10.1001/jama.2025.3471Diagnostic accuracy of late gadolinium enhancement cardiac MRI for coronary artery disease in patients with reduced left ventricular ejection fractionDoi: https://doi.org/10.1136/heartjnl-2024-325419Dapagliflozin in Patients Undergoing Transcatheter Aortic-Valve ImplantationDoi: https://doi.org/10.1056/NEJMoa2500366Scientific team:Ricardo Ladeiras Lopes, Mário Santos and João Sérgio NevesDiscover Medical Portfolio App weekly top picks - the latest and most relevant papers, curated by our team of experts! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://linktr.ee/medicalportfolioapp⁠

The controversial KETO-CTA study, tough decisions in subclinical AF, and another potentially huge benefit for GLP-1 agonist drugs are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I The KETO-CTA Study JACC Advances Paper: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686 Meta-analysis https://doi.org/10.1016/j.ajcnut.2024.01.009 II Subclinical AF – Anticoagulate or Not? Anticoagulation in Subclinical AF May Offer Little Benefit https://www.medscape.com/viewarticle/anticoagulation-subclinical-af-may-offer-little-benefit-2025a1000b31 Treat AFib ‘Diagnosed' by Smartwatch https://www.medscape.com/viewarticle/treat-afib-diagnosed-smartwatch-2025a1000avp JAMA NO paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833437 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 McIntyre meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067512 Singer et al https://pmc.ncbi.nlm.nih.gov/articles/PMC2777526/ Stroke paper https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.123.045843 American Journal of Medicine paper https://pubmed.ncbi.nlm.nih.gov/38331136/ III GLP1a for Treatment of Fatty Liver Disease ESSENCE trial https://www.nejm.org/doi/10.1056/NEJMoa2413258 Features CABG Still Superior to Stents Despite FAME 3 Endpoint Swap https://www.medscape.com/viewarticle/cabg-still-superior-stents-despite-fame-3-endpoint-swap-2025a1000ao5 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The FDA approval of TAVR for asymptomatic AS, digital health, subcutaneous vs transvenous ICD, and cryptogenic stroke in young adults are discussed by John Mandrola, MD. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I  FDA announces approval for TAVR in pts with asymptomatic AS Edwards Press Release https://www.edwards.com/newsroom/news/2025-05-01-edwards-tavr-receives-fda-approval-for-patients-with-asymptomatic-severe-aortic-stenosis Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis (EARLY TAVR) https://www.nejm.org/doi/full/10.1056/NEJMoa2405880 EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec Asymptomatic Aortic Stenosis: 'Time to Act' or Not So Fast? https://www.medscape.com/viewarticle/asymptomatic-aortic-stenosis-time-act-or-not-so-fast-2025a10005o9 II PPG that Can Distinguish source of Tachycardia Machine-learning guided differentiation between photoplethysmography waveforms of supraventricular and ventricular origin https://doi.org/10.1016/j.cmpb.2025.108798 III PRAETORIAN -XL trial Device-related Complications in Transvenous Versus Subcutaneous Defibrillator Therapy During Long-term Follow-up: the PRAETORIAN-XL Trial https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.074576 Subcutaneous or Transvenous Defibrillator Therapy (PRAETORIAN trial) https://www.nejm.org/doi/full/10.1056/NEJMoa1915932 Subcutaneous or Transvenous Defibrillator Therapy Letter to Editor https://www.nejm.org/doi/full/10.1056/NEJMc2034917 The PRAETORIAN Trial: Guarded Approach to Subcutaneous ICD Best https://www.medscape.com/viewarticle/937156 IV Stroke in Young People Burden of Modifiable Risk Factors in Young-Onset Cryptogenic Ischemic Stroke by High-Risk Patent Foramen Ovale https://www.ahajournals.org/doi/10.1161/STROKEAHA.124.049855 Migraine: A Key Factor in Young Adults With Unexplained Stroke https://www.medscape.com/viewarticle/migraine-key-factor-young-adults-unexplained-stroke-2025a10009jj U.S. stroke rate declining in adults 75 and older, yet rising in adults 49 and younger ASA statement https://newsroom.heart.org/news/u-s-stroke-rate-declining-in-adults-75-and-older-yet-rising-in-adults-49-and-younger Increasing stroke in the young https://doi.org/10.1016/j.ajpc.2020.100085 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week we review a recent editorial commentary by Drs. Belinda Gray, Rachel Lampert and Michael Papadakis on the concept of the personalized emergency action plan for the patient with genetic heart disease who is 'returning to play' in vigorous sports. With newer data demonstrating that risk for SCA or SCD is perhaps not as high as was once thought in this setting of sport, can the development of a personalized emergency action plan further enhance safety beyond simple measures such as medical adherence? Who should be involved in drafting this emergency action plan and how does this feature in the concept of 'shared decision-making'? DOI: 10.1161/CIRCULATIONAHA.124.072830

The FAME 3 trial 5-year results, TAVR at 5 years, pacers after TAVR, and mavacamten not a wonder drug are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I FAME 3 at Five Years Stents as Good as Surgery for Triple-Vessel Disease https://www.medscape.com/viewarticle/noninvasive-stents-good-surgery-triple-vessel-disease-2025a10007l4 Main trial NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2112299 Circulation 3-years https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065770 5-year results Lancet 10.1016/S0140-6736(25)00505-7 https://linkinghub.elsevier.com/retrieve/pii/S0140673625005057 II TAVR in Low-Risk Patients at 5 years 5-Year TAVR, Surgery Outcomes Similar in Low-Risk Patients https://www.medscape.com/viewarticle/5-year-tavr-surgery-outcomes-similar-low-risk-patients-2025a10007zl EVOLUT Low-Risk 5 years https://www.jacc.org/doi/10.1016/j.jacc.2025.03.004 EVOLUT Editorial – We're Halfway There https://www.jacc.org/doi/10.1016/j.jacc.2025.03.428 PARTNER 3 Low-Risk https://www.nejm.org/doi/full/10.1056/NEJMoa2307447 NOTION at 5 years https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036606 III The Matter of Pacemakers After TAVI JACC IV Study Badertscher https://www.jacc.org/doi/10.1016/j.jcin.2025.03.028 Assessing the quality of reporting of harms in randomized controlled trials published in high impact cardiovascular journals   IV Mavacamten Looks to Have Specific Indications EXPLORER HCM 10.1016/S0140-6736(20)31792-X External Link VALOR HCM https://jamanetwork.com/journals/jamacardiology/fullarticle/2809050 BMS Press Release https://news.bms.com/news/details/2025/Bristol-Myers-Squibb-Provides-Update-on-Phase-3-ODYSSEY-HCM-Trial/ FINAL THOUGHTS PRAGUE 25 https://bmjopen.bmj.com/content/12/6/e056522 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Understanding HIV and AIDS, including HIV virology, epidemiology as well as HIV symptoms (including WHO clinical classification and CDC CD4 count classification). Also covered is diagnosis and treatment including anti retroviral therapy (ART). Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is HIV? 0:28 HIV Microbiology1:36 HIV Pathophysiology2:17 HIV Epidemiology3:17 HIV Symptoms & Clinical Stages6:25 HIV Diagnosis8:00 HIV TreatmentReferencesBMJ Best Practice (2025) - “HIV in adults”. Available at https://bestpractice.bmj.com/topics/en-gb/555Mpiko Ntsekhe, MD, PhD and Jason V. Baker, MD, MSc (2022) - “Cardiovascular Disease Among Persons Living With HIV: New Insights Into Pathogenesis and Clinical Manifestations in a Global Context”. Available at https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.057443Virology Research Services (2022) - “The Virus of the Month - HIV”. Available at https://virologyresearchservices.com/2022/09/04/the-virus-of-the-month-hiv/Waymack JR, Sundareshan V. Acquired Immune Deficiency Syndrome. [Updated 2023 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available at https://www.ncbi.nlm.nih.gov/books/NBK537293/Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition. Geneva: World Health Organization; 2016. ANNEX 10, WHO clinical staging of HIV disease in adults, adolescents and children. Available at https://www.ncbi.nlm.nih.gov/books/NBK374293/fVirtual Mentor. 2010;12(3):202-206. doi: 10.1001/virtualmentor.2010.12.3.cprl1-1003. Available at https://journalofethics.ama-assn.org/article/who-clinical-staging-system-hivaids/2010-03Please remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

The TAP-IT, STRIDE, FreshUP, and SINGLE SHOT CHAMPION trials are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I TAP IT  TAP IT trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.073521 II STRIDE LANCET Ref 10.1016/S0140-6736(25)00509-4 SUMMIT HF https://www.nejm.org/doi/full/10.1056/NEJMoa2410027 III FRESH UP No Need to Restrict Fluids in Stable Heart Failure https://www.medscape.com/viewarticle/no-need-restrict-fluids-stable-heart-failure-2025a10008bu Nature (Trial) https://www.nature.com/articles/s41591-025-03628-4 SODIUM HF https://pubmed.ncbi.nlm.nih.gov/35381194/ IV PFA for AF ablation SINGLE SHOT CHAMPION https://www.nejm.org/doi/full/10.1056/NEJMoa2502280 ADVENT https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 Foy et al https://pmc.ncbi.nlm.nih.gov/articles/PMC11852674/ MANIFEST REDO Study https://doi.org/10.1093/europace/euaf012 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

It's a heart-to-heart on Spotlight today, as Gareth and Ross kick off by discussing a Discourse question about whether running marathons is bad for your heart? Ross describes five cardiac "risks" that have been documented, giving context and a bit of reassurance in response to theory that excessive endurance training is damaging to heart tissue. We then talk about maximum heart rate, and why it's an imperfect anchor for training prescription and a poor comparison between people. We shift from heart to brain to briefly discuss whether coaches should be sanctioned when players tackle poorly in rugby, and end off with a brief look at two teen phenoms competing in Australia last week, wondering whether their trajectories are inviting unreasonable pressure at too young an age.DiscourseAs always, Spotlight is inspired by your engagement in our Discourse community, and you can become a member by visting the Patreon site, and pledging a small monthly amount that gets you access and an opportunity to engage with, and learn from, fellow listeners.Show notesIan's question about heart risk from marathon running, and some excellent Discourse replies - Members onlyThe research paper on troponin elevation after marathons, which kicked off the Discourse discussion at the front of today's showGood insight and discussion on whether too much exercise is bad for you?Here's that article i mentioned where Tim Noakes punched some holes in the theory that marathon runners would be protected against coronary artery diseaseUltimately, sudden cardiac death in marathon runners is rare. Here's a review that explores just how rare, and explains the risksA Discourse thread on max HR and why it's a limited anchor and set ceiling for training prescription and managementHere's a paper that describes that sub-max HR test that can be used to identify training adaptation, overreaching and early signs of illness by looking at HR recovery after exerciseCompound Score revisited and re-explained - following last week's Spotlight, Ross shared more thoughts to explain the Compound Score. Here's that article, available to all, but initially on Discourse Get bonus content on Patreon Hosted on Acast. See acast.com/privacy for more information.

Stopping oral anticoagulation after AF ablation, the core problem with paradoxes like the smoker's paradox, chronic total occlusion PCI, and an ACC/EHRA preview are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Oral Anticoagulation after Successful AF Ablation Iwawakie et al https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831851 OCEAN protocol paper https://doi.org/10.1016/j.ahj.2017.12.007 II Smoker's Paradox Presch et al https://www.jacc.org/doi/10.1016/j.jcin.2024.12.028 Gupta et al https://doi.org/10.1161/JAHA.116.003370 III CTO PCI Main sub-analysis paper Bangalore et al https://doi.org/10.1016/j.jacc.2025.01.029 DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313 Main EURO CTO trial https://doi.org/10.1093/eurheartj/ehy220 3-year MACE of EURO CTO https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions EXPLORE https://www.jacc.org/doi/abs/10.1016/j.jacc.2016.07.744 ISCHEMIA CTO https://www.clinicaltrials.gov/study/NCT03563417   IV ACC and EHRA Preview Mandrola's 5 Trials to Look for at the 2025 American College of Cardiology Scientific Sessions https://www.medscape.com/viewarticle/mandrolas-5-trials-look-2025-american-college-cardiology-2025a10006zu You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

El ejercicio físico ha demostrado reducir el riesgo cardiovascular, pero algunos estudios sugieren que también aumenta las placas de ateroma, de forma paradójica. Hoy comentaremos algunos estudios, y qué recomiendan las guías clínicas respecto al ejercicio tras sufrir un infarto. Como siempre, os dejo algunos enlaces de interés: - Ejercicio e infarto, de Ismael Galancho: https://www.instagram.com/p/DGdOA2dK2i-/?hl=es&img_index=1 - Bibliografía comentada en el podcast, por si queréis profundizar: - https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae927/7951179 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061173 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.044467 - https://www.ahajournals.org/doi/10.1161/circulationaha.117.027834 - https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.032708 - ¿Cómo se calcula un MET? xhttps://www.cooperinstitute.org/blog/using-met-minutes-to-track-volume-of-physical-activity#:~:text=Walk%202%20days%20a%20week,%2B%20480%20%3D%20920%20MET%2Dminutes - VO2 Máx o aptitud cardiorrespiratoria, en Palabra de Runner: https://www.palabraderunner.com/vo2-max-que-es-y-formula/ Podéis encontrarme en: Facebook: Medciencia Twitter: @Medciencia Instagram: @DrRobertoMendez Tiktok: @Medciencia

Contributor: Aaron Lessen, MD Educational Pearls: Quick background info Cardiac arrest is when the heart stops pumping blood for any reason. This is different from a heart attack in which the heart is still working but the muscle itself is starting to die. One cause of cardiac arrest is when the electrical signals are very disrupted in the heart and start following chaotic patterns such as Ventricular tachycardia (VTach) and Ventricular fibrillation (VFib) One of the only ways to save a person whose heart is in VFib or VTach is to jolt the heart with electricity and terminate the dangerous arrhythmia. A recent study in the Netherlands looked at how important the time delay is from when cardiac arrest is first identified to when a defibrillation shock from an Automated External Defibrillator (AED) is actually given. Their main take-away: each minute defibrillation is delayed drops the survival rate by 6%! These findings reinforce the importance of rapid AED deployment and early defibrillation strategies in prehospital cardiac arrest response. References Stieglis, R., Verkaik, B. J., Tan, H. L., Koster, R. W., van Schuppen, H., & van der Werf, C. (2025). Association Between Delay to First Shock and Successful First-Shock Ventricular Fibrillation Termination in Patients With Witnessed Out-of-Hospital Cardiac Arrest. Circulation, 151(3), 235–244. https://doi.org/10.1161/CIRCULATIONAHA.124.069834 Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce, MS1 & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

The treatment of asymptomatic aortic stenosis, the move to composite endpoints in trials, IFR vs FFR and high-frequency low tidal volume ventilation for AF ablation are the topics John Mandrola, MD, discusses in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Aortic valve intervention for Asymptomatic AS Lindman editorial https://jamanetwork.com/journals/jamacardiology/fullarticle/2829881 Trends https://pmc.ncbi.nlm.nih.gov/articles/PMC11308430/ Podcast EARLY TAVR Nov 8, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001865 Faith Healing and Subtraction Anxiety https://www.ahajournals.org/doi/10.1161/circoutcomes.118.004665 Early TAVR trial https://www.nejm.org/doi/10.1056/NEJMoa2405880 EVOLVED https://jamanetwork.com/journals/jama/fullarticle/2825540 AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 II Trial Endpoints Shepshelovich https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2830023 Brown meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560 III IFR vs FFR—a debate b/w RCTs and observational data 5-year DEFINE https://jamanetwork.com/journals/jamacardiology/fullarticle/2824470 5-year SwedeHeart IFR https://doi.org/10.1016/j.jacc.2021.12.030 Eftekhari meta-analysis https://doi.org/10.1093/eurheartj/ehad582 Gotberg SWEDEHEART Registry https://doi.org/10.1016/j.jcin.2024.12.003 Editorial of SWEDEHEART-Registry https://doi.org/10.1016/j.jcin.2024.12.014 IV High-frequency low-tidal-volume ventilation for AF ablation Osorio et al https://doi.org/10.1016/j.hrthm.2024.07.094 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Due to advancements in medical and surgical care, the survival of patients with congenital conditions into adulthood has dramatically increased. However, as these individuals transition to adulthood, their unique physiology, chronic complications, and evolving care needs create significant challenges for their management when they are admitted to adult intensive care units (ICUs). This episode will discuss adult congenital disease in the ICU. Dr. Zanotti is joined by Dr. Cameron Dezfulian, a pediatric and adult critical care physician. He is the director of the Adult Congenital Heart Disease Program Development for the Section of Critical Care at Texas Children's Hospital and a faculty member at Cardiothoracic Critical Care at Baylor St. Luke's Medical Center. He is also a Senior Faculty member at Baylor College of Medicine in Houston, Texas. Additional resources: ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690 Special Considerations in Critical of the Congenital Heart Disease Patient. E Neethling, et al. Can J Cardiol. 2023: https://pubmed.ncbi.nlm.nih.gov/36682483/ Management of the Critically Ill Adult with Congenital Heart Disease. WB Kratzert, et al. J Cardiothorac Vasc Anesth 2018: https://pubmed.ncbi.nlm.nih.gov/29500124/ Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units. J Edwards, et al. J Crit Care 2015: https://pubmed.ncbi.nlm.nih.gov/25466316/ Down Syndrome. MJ Bull. N Eng J Med 2020. https://www.nejm.org/doi/full/10.1056/NEJMra1706537 Books and Music mentioned in this episode: The Bible: https://bit.ly/3EK4LL6

Blanking period after AF ablation, periprocedural MI after PCI in non-STEMI, predicting AF after ischemic stroke, and the proper standards for mitral valve repair in primary mitral regurgitation are the topics John Mandrola, MD, discusses in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I AF blanking period CIRCA DOSE Research letter https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013232 Circa-Dose https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622 COMPARE CRYO  https://doi.org/10.1016/j.jacep.2024.03.021 Mohanty et al  10.1016/j.hrthm.2024.08.011 Ruzieh, Foy, Mandrola Patients' Lives Don't Pause for Blanking Periods https://doi.org/10.1016/j.ahjo.2024.100497 II Periprocedural MI and Future events Circulation paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070729 III AI to detect AF related stroke eClinical Medicine Paper  https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00050-1/fulltext IV Mitral Valve Repair JACC paper -- https://doi.org/10.1016/j.jacc.2024.10.108 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

February 7-14 is Congenital Heart Disease Awareness Week. In this, Dr. Sergio Zanotti discuss adult congenital heart disease through the lens of his experience as a patient. He shares some reflections based on my experience as a lifelong patient with complex adult congenital heart disease and a recent procedure that allowed him to experience medical care from the patient side. Additional resources: ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690 The Bell Curve. By Atul Gawande. The New Yorker 2004: https://www.newyorker.com/magazine/2004/12/06/the-bell-curve Website for the Adult Congenital Heart Association: https://www.achaheart.org/ Books and music mentioned in this episode: Montaigne. By Stefan Zweig: https://bit.ly/4gEOVP2 The Heart. A Novel. By Maylis De Kerangal: https://bit.ly/41ehqin The Essays: A Selection (Penguin Classics). By. Michel de Montaigne: https://bit.ly/3EvFwvW

February 7-14 is Congenital Heart Disease Awareness Week. In this, Dr. Sergio Zanotti discuss adult congenital heart disease through the lens of his experience as a patient. He shares some reflections based on my experience as a lifelong patient with complex adult congenital heart disease and a recent procedure that allowed him to experience medical care from the patient side. Additional resources: ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690 The Bell Curve. By Atul Gawande. The New Yorker 2004: https://www.newyorker.com/magazine/2004/12/06/the-bell-curve Website for the Adult Congenital Heart Association: https://www.achaheart.org/ Books and music mentioned in this episode: Montaigne. By Stefan Zweig: https://bit.ly/4gEOVP2 The Heart. A Novel. By Maylis De Kerangal: https://bit.ly/41ehqin The Essays: A Selection (Penguin Classics). By. Michel de Montaigne: https://bit.ly/3EvFwvW

Join our scientific team in the discussion of the 3 most clinically impactful papers of the month, the crème de la crème of our weekly top picks.This month we're discussing:Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in ScotlandDOI: 10.1016/S0140-6736(24)02679-5Subcutaneous weekly semaglutide with automated insulin delivery in type 1 diabetes: a double-blind, randomized, crossover trialDOI: https://doi.org/10.1038/s41591-024-03463-zEvidence-Based Application of Natriuretic Peptides in the Evaluation of Chronic Heart Failure With Preserved Ejection Fraction in the Ambulatory Outpatient SettingDOI: https://doi.org/10.1161/CIRCULATIONAHA.124.072156Scientific team:Ricardo Ladeiras Lopes, Mário Santos and João Sérgio NevesDiscover Medical Portfolio App weekly top picks - the latest and most relevant papers, curated by our team of experts! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://linktr.ee/medicalportfolioapp⁠

Our initial review of the PLATO trial, published in April 2024, was based on the data available to us at that time. We have since became aware of new information that reduces our confidence in the PLATO results. This new information has major implications for clinical practice. Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Despite representing only 6.9% of the total P2Y12 inhibitor prescriptions among Medicare beneficiaries in 2020, Ticagrelor accounted for nearly two-thirds of total Medicare spending on these drugs in the same year. We summarize important points below but you can refer to this investigation at BMJ for more details.1. Unexplained Regional Variation: In our original review, we highlighted the treatment effect interaction based on region of enrollment, where ticagrelor was less effective compared to clopidogrel for patients enrolled in North America. It appeared to be a strong signal and was associated with a p-value for the interaction of 0.05. However, we were cautious in our interpretation since overall, patients enrolled in North America represented a relatively small fraction of total patients and we could not think of a reasonable explanation.Information in the BMJ investigation now sheds new light on these findings. In our review, we only presented data contained in the supplement accompanying the PLATO trial manuscript, which categorized patients based on region of enrollment but did not provide country specific information. The BMJ report notes that in a separate subgroup analysis, based on country of randomization, the primary outcome was numerically higher with ticagrelor in the United States (12.6% vs 10.1%, HR: 1.27, 95% CI: 0.92 – 1.75). This subgroup represented 7.6% of the total trial participants. Overall, 9.7% of trial participants were enrolled from North America. This means the US data drove the findings from the North American subgroup.The explanation provided by AstraZeneca (the manufacturer of ticagrelor) to explain the observed treatment effect heterogeneity was that aspirin dosing in the United States was higher than in other countries. It even led the FDA to issue a black box warning to avoid an aspirin maintenance dose of >100 mg in patients taking ticagrelor. An extensive statistical analysis of the regional variation in PLATO yielded four interesting points. First what was the prior likelihood of observing a ticagrelor vs clopidogrel HR of > 1.25 in the US, when the overall HR was actually equal to 0.84? That probability is ≤ 0.01. This alone suggests more than chance. Second point: a strong US/nonUS interaction was noted for each of the 3 components of the primary endpoint—CV death, MI, stroke. Third: they found a very strong interaction between treatment and median aspirin dose, and, importantly, the aspirin interaction effect was similar in US and nonUS settings. Fourth, an analysis of contract research organization (CRO) vs sponsor monitoring of the site accounted for 61% of the treatment-by- region interaction. The authors downplayed this finding because of the four countries monitored by a CRO (Israel, US, Georgia and Russia), the US made up the majority and thus is confounded by the aspirin interaction. Noteworthy was a lack of direct analysis of CRO vs sponsor test for interaction. One problem though: the BMJ investigation found that the lead author, Kevin Carroll was the head statistician at AstraZeneca and had worked at the company for 20 years. Carroll presented the PLATO results at the FDA advisory meeting. The paper lists Carroll as having no conflicts. Carroll told the BMJ that he had disposed of all conflicts of interest before submitting that analysis. But, in our opinion, the aspirin explanation does not pass muster because of biologic implausibility. See next section: How would a higher dose of aspirin reduce the efficacy of ticagrelor?The primary composite endpoint was vascular death, MI or stroke. If the higher aspirin dose impacted this, we would hypothesize that it caused more major bleeding in the ticagrelor group with some events resulting in vascular death, type 2 MI and hemorrhagic stroke, driving the treatment effect in favor of clopidogrel. But there is no evidence of this.The figure below is from the original subgroup plots provided in the PLATO supplement. The difference in the treatment effect for the primary endpoint for North American patients is striking but there is no difference for major bleeding.In our opinion and the opinion of others, the role of supervision of the centers could be important. Most centers were monitored by the sponsor. Four countries (Israel, US, Georgia and Russia) were monitored by a contract research organization. All four of these countries had numerically higher rates of the primary outcome in the ticagrelor group. This has major implications and we do not take them lightly. Essentially, it suggests malfeasance on the part of the sponsor. So is there anything else to support such a claim? Well, yes. 2. Concerns about event adjudication. Based on a report from Victor Serebruany, an adjunct faculty member at Johns Hopkins University, and the BMJ investigation, FDA records indicated that site reports documented 504 myocardial infarctions in patients who received ticagrelor compared to 548 in patients who received clopidogrel. However, after adjudication, the count increased only for the clopidogrel group, reaching 593. There was also some imbalance among groups in adjudicating death. These imbalances raise concerns about potential unblinding and result tampering. We read many of the authors' replies and we did not find a clear explanation of why all readjudicated extra MIs were in the clopidogrel group (45 clopidogrel; ticagrelor 0). 3. There were also concerns about the accuracy of death records as sites death records did not always match the FDA records.We cite from the BMJ: The BMJ's analysis also found omissions in PLATO's landmark publication. The paper, published in NEJM and reported as an intent-to-treat analysis, reports 905 total deaths from any cause among all randomized patients. An internal company report states, however, that 983 patients had died at this point. While 33 deaths occurred after the follow-up period, the NEJM tally still leaves out 45 deaths “discovered after withdrawal of consent.” The BMJ obtained some records for patients whose deaths were not reported in NEJM (see table 1) and asked the journal for a response.NEJM editor in chief Eric Rubin told The BMJ that “for older manuscripts, correction is not necessarily appropriate unless there would be an effect on clinical practice,” concluding that “it does not appear that correcting this 15-year-old article is going to have any impact.”It is noteworthy that the United States Department of Justice launched a formal investigation into the PLATO trial in 2013; however, the probe was closed in 2014. The BMJ column cited a spokesperson for the US attorney's office who said…”we determined that the allegations lacked sufficient merit such that it was not in the best interests of the US to intervene in the suit.” 4. Mortality reduction in PLATO defies explanation: Shortly after PLATO was published, Drs. Victor Serebruany and Dan Atar wrote an editorial in the European Heart Journal titled: The PLATO trial: do you believe in magic? They noted that the overall HR for all-cause death ticagrelor vs clopidogrel was 0.78 (95% CI: 0.69 - 0.89; p< 0.001). There were 107 more lives saved with ticagrelor vs clopidogrel. To explain the surprise of this massive effect size, they compared it to the COMMIT trial of clopidogrel vs placebo in patients with acute MI. In COMMIT, 119 lives were saved with clopidogrel (vs placebo), but COMMIT had three-fold more patients than PLATO—and the gain was vs placebo. They tempt the reader to ask: how could ticagrelor fare that well against a drug that crushed placebo? We note two other reasons to be concerned about the outsized mortality reduction in PLATO. One is plausibility. The all-cause mortality benefit exceeded the reduction in MI, CV death or stroke. Given the numerically higher rate of bleeding, how else does ticagrelor reduce death vs clopidogrel? The second reason is the lack of such a signal in Phase 2 studies, such as this one. 5. PLATO results are on outlier: Multiple observational studies have failed to replicate the benefits of ticagrelor observed in the PLATO trial. While observational studies are inherently limited by confounding factors and are inferior to randomized trials, their findings warrant a re-evaluation of ticagrelor's benefits. Furthermore, two randomized trials—one conducted predominantly in Japanese patients and another in South Korea—did not demonstrate the superiority of ticagrelor, instead showing higher bleeding rates and a numerical increase in ischemic events.Ticagrelor also significantly underperformed against another new antiplatelet drug, prasugrel. In the non-industry-funded ISAR-REACT 5 trial, which enrolled patients with acute coronary syndrome, the primary event of death, MI, or stroke was 36% higher in the ticagrelor arm (9.3% vs 6.9%, HR 1.36, 95% CI: 1.09 - 1.70). Major bleeding was also numerically higher in the ticagrelor arm. 6. PLATO authors have responded to these arguments.We provide links to four of the authors responses. * Thrombosis and Hemostasis https://www.wellesu.com/10.1160/TH11-03-0162* Stroke https://www.ahajournals.org/doi/10.1161/strokeaha.111.000514* Inter J of Cardiol https://doi.org/10.1016/j.ijcard.2014.06.029* Circulation https://doi.org/10.1161/CIRCULATIONAHA.111.047498Conclusion These are vitally important revelations regarding PLATO and ticagrelor. The FDA advisory committee recommended that FDA require a confirmatory trial. This was not done. As such, ticagrelor gained serious market share in the non-clopidogrel antiplatelet market for more than a decade. Yet no other compelling evidence for its benefit over clopidogrel has come to light. It clearly underperformed vs prasugrel. These old and new revelations have changed our positive view of ticagrelor. We no longer have confidence in this drug. We strongly agree with the recommendation for another properly controlled trial. We also believe this highlights the benefits of having either two regulatory trials or a single regulatory trial combined with a mandated post-approval trial. These revelations also emphasize the benefits of robust critical appraisal and skeptical but not cynical approaches to surprising evidence. Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Listener feedback, multiple studies in AF ablation, a DANISH trial substudy of ICDs in NICM, and more data on eye complications of GLP-1 agonists are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. CCTA Feedback Foy meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243 DANCAVAS https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 II. Listener Feedback on my negative take of the OPTION Trial. Option trial https://www.nejm.org/doi/pdf/10.1056/NEJMoa2408308 My Preview https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz 4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u III. AF Ablation  PVI Add-Ons Provide Better Control of Persistent AF https://www.medscape.com/viewarticle/pvi-add-ons-provide-better-control-persistent-af-2024a1000lcm VENUS https://jamanetwork.com/journals/jama/fullarticle/2772281 PROMPT AF https://jamanetwork.com/journals/jama/fullarticle/2826710 STAR AF 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 CRRF-PeAF https://pmc.ncbi.nlm.nih.gov/articles/PMC9241129/ CAVAC trial https://doi.org/10.1161/CIRCEP.124.012917 CRRF-PeAF from multiple centers in Japan (not published) IV. DANISH Trial Substudy Danish Trial Substudy https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.124.071777 Danish Main https://www.nejm.org/doi/full/10.1056/NEJMoa1608029 MADIT-2 EF Substudy https://doi.org/10.1016/S0002-9149(01)01729-5 SCD-HeFT subgroup https://www.nejm.org/doi/full/10.1056/NEJMoa043399 Appraisal of ICD to Prevent SCD https://doi.org/10.1016/j.jacc.2008.05.058 V. Eye disease and GLP-1 Agonists Jul 26, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001384 Semaglutide vs No Semagutide and Eye Disease https://link.springer.com/epdf/10.1186/s40942-024-00620-x Semaglutide vs SGLT- Inhibitors and Eye Disease https://www.medrxiv.org/content/10.1101/2024.12.09.24318574v1.full-text You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

A recent study suggests just 5 minutes of exercise could help lower blood pressure. The researchers found that replacing any less active behaviour with five minutes of vigorous exercise could help lower blood pressure. The message here is get your heart pumping, by integrating short bursts of activity into your daily routine. It can be climbing stairs at work, parking further away from the store entrance or even jumping on your bike to cycle to get your mail......walking, jogging, cycling or swimming....whatever you do to move that body, helps your circulation, heart and blood pressure. And increasing your daily activity up to 20 minutes can reduce the risk of heart disease by a significant amount. Study in Circulation:  ⁠⁠https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069820⁠⁠ Enjoying the show? Consider leaving a 5 star review, and/or sharing this episode with your friends and family :) Sign up for our newsletter on our website for weekly updates and other fun info. You can also visit our social media pages. We're on Facebook, Instagram, and YouTube. Your support helps fuel the stoke and keeps the show going strong every week. Thanks! Website: www.mywifethedietitian.com Email: mywifetherd@gmail.com

US doc's pay, the ticagrelor controversy and new RCTs, clopidogrel beats ASA, holding antiplatelets for non-cardiac surgery, and Prof Cleland and ASA dogma are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. US Healthcare Mandrola's Top 10 Stories in 2024 https://www.medscape.com/viewarticle/mandrolas-top-10-stories-2024-2024a1000mxe?_gl=1*dcvmkh*_gcl_au*MTgzOTY2ODQ0Ni4xNzI5MjU4NjUz CMS Proposal II. Ticagrelor Controversy New Investigation Casts Doubt on Landmark Ticagrelor Trial https://www.medscape.com/viewarticle/new-investigation-casts-doubt-landmark-ticagrelor-trial-2024a1000n1d Doshi Review https://www.bmj.com/content/387/bmj.q2550 PLATO https://www.nejm.org/doi/full/10.1056/NEJMoa0904327 ISAR REACT 5 https://www.nejm.org/doi/full/10.1056/NEJMoa1908973 Bates Review https://www.ahajournals.org/doi/epub/10.1161/JAHA.123.031606 Victor Serebuany and Dan Atar Editorial https://doi.org/10.1093/eurheartj/ehp545 III. New Ticagrelor vs Clopdiogrel trial Preprint: https://www.medrxiv.org/content/10.1101/2024.11.06.24316875v1.full-text IV. Clopidogrel Better Than ASA Even in HBR Substudy Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity HOST-EXAM 10.1016/S0140-6736(21)01063-1 HOST-EXAM-Extended https://doi.org/10.1161/CIRCULATIONAHA.122.062770 V. ASA During Non-Cardiac Surgery ASSURE DES https://doi.org/10.1016/j.jacc.2024.08.024 VII. Professor Cleland on ASA for Secondary Prevention Cleland Editorial https//jamanetwork.com/journals/jamacardiology/article-abstract/2827201 ASA Meta-analysis 10.1016/S0140-6736(09)60503-1 AMIS https://jamanetwork.com/journals/jama/fullarticle/368745 SAPAT 10.1016/0140-6736(92)92619-Q You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The EARLY TAVR trial, colchicine after MI, and the TRISCEND II trial of tricuspid valve replacement are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Early TAVR EARLY TAVR https://www.acc.org/latest-in-cardiology/clinical-trials/2024/10/24/14/42/early-tavr Rationale https://doi.org/10.1016/j.ahj.2023.11.019 AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 RECOVERY https://www.nejm.org/doi/full/10.1056/NEJMoa1912846 FAME 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1205361 Rajkumar; Faith Healing in Unblinded Trials https://pubmed.ncbi.nlm.nih.gov/29530888/ PARTNER 3 trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307447 EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec II. Colchicine Meta-analysis https://doi.org/10.1016/j.eclinm.2024.102835 Clear-Synergy Rationale https://pubmed.ncbi.nlm.nih.gov/38936755/ COLCOT (post MI) https://www.nejm.org/doi/full/10.1056/NEJMoa1912388 LoDoCo (Chronic CAD) https://www.nejm.org/doi/full/10.1056/NEJMoa2021372   III. TRISCEND II Trial TRISCEND II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2401918 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-405 Overview: Explore the American Heart Association's (AHA) newly validated risk calculator, designed to assess the likelihood of cardiovascular disease and heart failure in patients aged 30-79 years. Hear which risk factors are included, why they matter, and how this tool can enhance your preventive care strategies in primary care practice. Episode resource links: Hypertension. 2024;81:00–00. DOI: 10.1161/HYPERTENSIONAHA.124.22998.) https://doi.org/10.1161/CIRCULATIONAHA.123.067626 The calculator: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator Guest: Robert A. Baldor MD, FAAFP  Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-405 Overview: Explore the American Heart Association's (AHA) newly validated risk calculator, designed to assess the likelihood of cardiovascular disease and heart failure in patients aged 30-79 years. Hear which risk factors are included, why they matter, and how this tool can enhance your preventive care strategies in primary care practice. Episode resource links: Hypertension. 2024;81:00–00. DOI: 10.1161/HYPERTENSIONAHA.124.22998.) https://doi.org/10.1161/CIRCULATIONAHA.123.067626 The calculator: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator Guest: Robert A. Baldor MD, FAAFP  Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

In this eye-opening episode of the *Grow or Die* podcast, I take a deep dive into the oversimplified concept of "Calories In, Calories Out" (CICO). We explore why this approach to weight loss and metabolism is outdated, ineffective, and, in some cases, even harmful. I break down the science behind metabolism, dispelling common misconceptions and explaining how factors like basal metabolic rate, hormones, and nutrient absorption play critical roles in achieving and maintaining a healthy weight. You'll hear about real-world examples, like the contestants from The Biggest Loser and their struggles with weight regain, as well as the impact of severe caloric restriction on metabolism. We also cover the importance of understanding metabolic pathways, the role of polyunsaturated fatty acids, and how crash dieting can lead to long-term metabolic damage. Whether you're looking to optimize your health or curious about the science behind metabolism, this episode has the information you need to rethink how you approach weight loss.   Timestamps: - [00:28] – Sneak peek into the episode. - [1:41] – What is CICO, and why is it an oversimplification of human metabolism? - [2:41] – Why most people following CICO are unaware of metabolic dysfunctions. - [4:10] – How biofilms in the gut can impair nutrient absorption and affect metabolism. - [5:05] – The dangers of decreasing calories to unhealthy levels and how this impacts your metabolism long term. - [6:18] – The decline in metabolic rate over the last century and its contribution to rising obesity rates. - [8:09] – Explaining the second law of thermodynamics and why "a calorie is not a calorie" when it comes to metabolism. - [9:46] – The role of macronutrients in producing ATP and how different foods impact metabolism. - [11:54] – Debunking the idea that all fats and oils are created equal: Why polyunsaturated fatty acids may slow metabolism. - [14:07] – Lessons from historical diets and why past generations could eat more and maintain lower body weights. - [17:02] – The alarming rise in omega-6 intake and its negative effects on thyroid health and metabolism. - [20:36] – Why crash dieting leads to weight regain and long-term damage to basal metabolic rate. - [21:50] – How the body conserves energy during times of severe caloric restriction, and why this is counterproductive for weight loss. - [23:41] – The role of hormones in regulating metabolism, and how improper macronutrient ratios can harm thyroid health. - [27:16] – The benefits of prioritizing carbohydrates and lowering protein intake in certain health phases to boost metabolic function. - [31:00] – Why the majority of adults experience hypothyroidism and how modern blood tests miss the signs of metabolic dysfunction. - [35:12] – Actionable steps to improve metabolic health, including avoiding polyunsaturated fats, supporting liver function, and balancing hormones.   Links & Resources: Follow Me On Instagram: @jmihaly_ Follow "Grow or Die" On Instagram: @growordiepodcast Work With Me: https://www.togethermorefit.com/founder Join Substack For More Exclusive Content: https://justinmihaly.substack.com/ Join Patreon For More Exclusive Content: https://patreon.com/JustinMihaly?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink Sign Up For The Together More Elite Mentorship: https://togethermorefit.com/elitepurchase   Sources: 1. 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Listener feedback on the c-statistic, atherosclerotic plaque imaging, WATCHMAN implant decisions in the US, and deprescribing are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I.Listener Feedback Oct 11, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001735 Nancy Cook; C-statistic https://doi.org/10.1161/CIRCULATIONAHA.106.672402 II. Plaque Imaging New Evidence That Plaque Buildup Shouldn't Be Ignored https://www.medscape.com/viewarticle/new-evidence-plaque-buildup-shouldnt-be-ignored-2024a1000ihw Fuster and colleagues; Imaging vs CAC   III. WATCHMAN Decisions Zeitler and colleagues. Long-term Outcomes IV. Deprescribing Cognitive Decline and Antihypertensive Use: New Data https://www.medscape.com/viewarticle/cognitive-decline-and-antihypertensive-use-new-data-2024a1000isw?form=fpf Jing and colleagues. You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Reader feedback on LGE pre-ICDs, PFA for AF ablation, CTO-PCI, endovascular ablation of the greater splanchnic nerve in HFpEF, and data sharing are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Listener Feedback Sept 27, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001666 JAMA Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/2823869/ II. Pulsed Field Ablation for AF Feb 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/999995 ADMIRE Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070333 ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 III. PCI for CTO EuroCTO One Year SAQ Results https://doi.org/10.1093/eurheartj/ehy220 EuroCTO Hard Outcomes https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions Faith Healing and Subtraction Anxiety https://doi.org/10.1161/CIRCOUTCOMES.118.004665 DECISION CTO trial https://doi.org/10.1161/CIRCULATIONAHA.118.031313 ISCHEMIA CTO Rationale and Design https://doi.org/10.1016/j.ahj.2022.11.016 IV. Greater Splanchnic Nerve Ablation for HFpEF REBALANCE HF https://jamanetwork.com/journals/jamacardiology/fullarticle/2823999 V. Data Sharing The Pros and Cons of Clinical Trial Data Sharing https://www.medscape.com/viewarticle/862815 Kramer and Nallamothu, Caution in Data Sharing https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.124.010257 Nosek, Variability in Analytic Methods https://journals.sagepub.com/doi/10.1177/2515245917747646 Zeraatker, Variability in Analytic Methods   You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland. DOI: 10.1161/CIRCULATIONAHA.122.063281

Pedro Magno e Kaue Malpighi falam sobre o passo a passo da prescrição de rivaroxabana e apixabana: quando indicar? o que orientar o paciente? qual dose tomar? Tudo nesse episódio! No Guia TdC comentamos sobre como reverter o sangramento associado aos DOACs. Você pode ler esse tópico gratuitamente, basta clicar no link abaixo e fazer o login: Manejo de Sangramento Maior em Pacientes em Uso de Anticoagulante Oral | Guia TdC (tadeclinicagem.com.br) Referência: Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi:10.1093/eurheartj/ehz405 Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) [published correction appears in Eur Heart J. 2021 Feb 1;42(5):507. doi: 10.1093/eurheartj/ehaa798] Siontis KC, Zhang X, Eckard A, et al. Outcomes Associated With Apixaban Use in Patients With End-Stage Kidney Disease and Atrial Fibrillation in the United States [published correction appears in Circulation. 2018 Oct 9;138(15):e425. doi: 10.1161/CIR.0000000000000620]. Circulation. 2018;138(15):1519-1529. doi:10.1161/CIRCULATIONAHA.118.035418 Holt A, Strange JE, Rasmussen PV, et al. Bleeding Risk Following Systemic Fluconazole or Topical Azoles in Patients with Atrial Fibrillation on Apixaban, Rivaroxaban, or Dabigatran. Am J Med. 2022;135(5):595-602.e5. doi:10.1016/j.amjmed.2021.11.008 Beyer-Westendorf J, Siegert G. Of men and meals. J Thromb Haemost. 2015;13(6):943-945. doi:10.1111/jth.12973

Remember when we learned interruptions in compressions take a long time to recover blood pressure from? And how, to avoid these, we should do continuous compressions to avoid them. And ventilations aren't all that important. Right? Right? Well, about that. Maybe the stories of the importance of continuous compressions were greatly exaggerated. Join Dr. Jarvis as he discusses the literature that led us to this point and some evidence that has led him to reconsider how his system approaches cardiac arrest. He'll eventually get around to discussion a recent paper by Dr. Rose Yin that analyzes arterial pressures during cardiac arrest that was a catalyst for him to make changes in his arrest protocols. Citations:1. Yin RT, Berve PO, Skaalhegg T, et al. Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest. Resuscitation. 2024;201:110311. doi:10.1016/j.resuscitation.2024.110311 2. Azcarate I, Urigüen JA, Leturiondo M, et al. The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation. JCM. 2023;12(21):6918. doi:10.3390/jcm122169183. Berg RA, Sanders AB, Kern KB, et al. Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest. Circulation. 2001;104(20):2465-2470. doi:10.1161/hc4501.0989264.Kern KB, Hilwig RonaldW, Berg RA, Ewy GA. Efficacy of chest compression-only BLS CPR in the presence of an occluded airway. Resuscitation. 1998;39(3):179-188. doi:10.1016/S0300-9572(98)00141-55. Bobrow BJ, Clark LL, Ewy GA, et al. Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest. JAMA. 2008;299(10):1158-1165.6. Idris AH, Aramendi Ecenarro E, Leroux B, et al. Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023;148(23):1847-1856. doi:10.1161/CIRCULATIONAHA.123.0655617. Nichol G, Leroux B, Wang H, et al. Trial of Continuous or Interrupted Chest Compressions during CPR. N Engl J Med. 2015;373(23):2203-2214. doi:10.1056/NEJMoa1509139 8. Schmicker RH, Nichol G, Kudenchuk P, et al. CPR compression strategy 30:2 is difficult to adhere to, but has better survival than continuous chest compressions when done correctly. Resuscitation. 2021;165:31-37. doi:10.1016/j.resuscitation.2021.05.027 9. Zhan L, Yang LJ, Huang Y, He Q, Liu GJ. Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Anaesthesia C and ECG, ed. Cochrane Database of Systematic Reviews. Published online 2017. doi:10.1002/14651858.cd010134.pub2 10. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109(16):1960-1965. doi:10.1161/01.CIR.0000126594.79136.61

Prediction models vs clinical judgement, CCTA quantification of atherosclerosis, AF ablation plus LAAO, atrial shunt devices, and HF medical therapy are topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I.Clinical Prediction Models vs Clinical Judgement Did Statin Decision-Making Just Get Harder?  https://www.medscape.com/viewarticle/did-statin-decision-making-just-get-harder-2024a1000egl Colunga-Lozano and colleagues https://doi.org/10.1016/j.jclinepi.2023.10.016 Aug 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001429 II. CCTA Quantification of Atherosclerosis Atherosclerosis Quantification and Cardiovascular Risk: the ISCHEMIA Trial https://doi.org/10.1093/eurheartj/ehae471 Circulation ISCHEMIA sub study 2021 – Severity of CAD and Outcomes https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049755 ISCHEMIA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1915922 III. Combined AF Ablation and LAAO Review from Mills and colleagues https://doi.org/10.1016/j.tcm.2023.11.003 Link to CMS Rule on AF Ablation and LAAO https://hrs2.informz.net/z/cjUucD9taT05MjU3ODgyJnA9MSZ1PTkwMDQ2MTk4MCZsaT04NTU1OTQxMg/index.html IV. Atrial Shunt Devices No Net HF Benefit for Interatrial Shunt Device https://www.medscape.com/viewarticle/no-net-hf-benefit-interarterial-shunt-device-2024a10006kk Original REDUCE-LAP-HF-II https://doi.org/10.1016/S0140-6736(22)00016-2 Two-year results of REDUCE-LAP-HF-II https://doi.org/10.1016/j.jchf.2024.04.011 Apr 19, 2024 This Week in Cardiology Podcast V. Optimal HF Therapy Rao and colleagues; CHAMP HF https://doi.org/10.1016/j.jchf.2024.05.026 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Venous closure devices, GLP1-s linked to blindness and cancer, resisting the urge to do an ECG, and transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation are the topics discussed this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study https://doi.org/10.1093/europace/euae105 II GLP1-s and Blindness Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255 Locke Twitter  https://x.com/doc_BLocke/status/1808972226655629610 When to Start a Statin Is a Preference-Sensitive Decision https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808 III GLP1-s and Cancer Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820833 IV Screening ECG Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721 Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP)  https://doi.org/10.1016/S0140-6736(21)01637-8 Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study) https://doi.org/10.1016/S0140-6736(21)01698-6 IV TEER for Secondary Mitral Regurgitation Randomized investigation of the MitraClip device in heart failure: Design and rationale of the RESHAPE-HF2 trial design https://doi.org/10.1002/ejhf.3247 Percutaneous repair of moderate-to-severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE-HF2 trial and comparison to COAPT and MITRA-FR trials https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3286 Jun 21, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001237 Stats Blog https://www.r-bloggers.com/2023/07/the-benjamini-hochberg-procedure-fdr-and-p-value-adjusted-explained/ You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Let's talk about this news: https://news.abs-cbn.com/lifestyle/2024/6/25/ex-pbb-housemate-ryan-james-bacalla-is-now-a-lady-2141 And the harms of hormone therapy: https://thrombosis.org/2023/05/transgender-bloodclots-hormone-therapy/ https://pubmed.ncbi.nlm.nih.gov/29987313/ https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.038584 - - -  The Sentinel Ph:  Follow on Facebook: https://www.facebook.com/TheSentinelPh  - - -  You can help SUPPORT THIS PODCAST thru:  Shopee – Arugaan Online Shop:  Fight this toxic culture in style! Order your THE JAY ARUGA SHOW podcast T-shirt now:  https://shopee.ph/product/274489164/24822983311/  Buying me a coffee thru: https://www.buymeacoffee.com/thejayarugashow  - - -  Today's Sponsor:  Hallow - Try Hallow's premium contents for FREE: https://hallow.com/jayaruga  - - -  Socials:  Follow on Twitter: https://twitter.com/jagaruga  Follow on Instagram: https://www.instagram.com/jay.aruga  Follow on Facebook: https://www.facebook.com/TheJayArugaShow  Subscribe on YouTube: https://www.youtube.com/c/JayAruga  --- Send in a voice message: https://podcasters.spotify.com/pod/show/thejayarugashow/message

Contributor: Travis Barlock MD Educational Pearls: Wide-complex tachycardia is defined as a heart rate > 100 BPM with a QRS width > 120 milliseconds Wide-complex tachycardia of supraventricular origin is known as SVT with aberrancy Aberrancy is due to bundle branch blocks Mostly benign Treated with adenosine or diltiazem Wide-complex tachycardia of ventricular origin is also known as VTach Originates from ventricular myocytes, which are poor inherent pacemakers Dangerous rhythm that can lead to death Treated with amiodarone or lidocaine 80% of wide-complex tachycardias are VTach 90% likelihood for patients with a history of coronary artery disease In assessing a wide-complex tachycardia, it is best to treat it as a presumed ventricular tachycardia Treating SVT with amiodarone or lidocaine does no harm  However, treating VTach with adenosine or diltiazem may worsen the condition References 1. Littmann L, Olson EG, Gibbs MA. Initial evaluation and management of wide-complex tachycardia: A simplified and practical approach. Am J Emerg Med. 2019;37(7):1340-1345. doi:https://doi.org/10.1016/j.ajem.2019.04.027 2. Viskin S, Chorin E, Viskin D, Hochstadt A, Schwartz AL, Rosso R. Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy. Circulation. 2021;144(10):823-839. doi:10.1161/CIRCULATIONAHA.121.055783 3. Williams SE, O'Neill M, Kotadia ID. Supraventricular tachycardia: An overview of diagnosis and management. Clin Med J R Coll Physicians London. 2020;20(1):43-47. doi:10.7861/clinmed.cme.20.1.3 Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce & Jorge Chalit

¡Bienvenidos! Soy el Dr. Mau, médico especialista en medicina interna, emergencias y obesidad. En este video, hablaremos en profundidad sobre la Trombosis Venosa Profunda (TVP), una condición médica grave que puede tener consecuencias serias si no se trata a tiempo. ¿Qué es la TVP? La TVP ocurre cuando se forma un coágulo de sangre en una vena profunda del cuerpo, comúnmente en las piernas. Este coágulo puede causar dolor e hinchazón y, si se desprende, puede viajar a los pulmones y causar una embolia pulmonar, una complicación potencialmente mortal. ¿En qué puede desencadenar la TVP? La TVP puede llevar a complicaciones severas como la embolia pulmonar y el síndrome postrombótico, que puede causar dolor crónico y edema en las piernas. Es crucial reconocer los síntomas a tiempo para prevenir estas complicaciones. ¿Cómo se previene la TVP? Hablaremos sobre las mejores prácticas para prevenir la TVP, incluyendo la importancia de mantenerse activo, evitar periodos prolongados de inmovilidad, y utilizar medias de compresión si es necesario. También discutiremos factores de riesgo y cómo manejarlos. ¿Cómo se trata la TVP? Exploraremos los tratamientos disponibles para la TVP, que incluyen anticoagulantes, trombolíticos y en algunos casos, intervenciones quirúrgicas. Además, daremos recomendaciones sobre cómo cuidar tu salud vascular a largo plazo. Acompáñame en este video informativo y aprende cómo protegerte a ti y a tus seres queridos de esta peligrosa condición. ¡No olvides suscribirte al canal y activar la campanita para no perderte ninguno de mis videos! Fuentes: Overview of the causes of venous thrombosis UpToDate, 2023. Steffen, L., Folsom, A., Cushman, M., Jacobs, D., & Rosamond, W. (2006). Greater Fish, Fruit, and Vegetable Intakes Are Related to Lower Incidence of Venous Thromboembolism: The Longitudinal Investigation of Thromboembolism Etiology. Circulation, 115, 188-195. https://doi.org/10.1161/CIRCULATIONAHA.106.641688. Learn more about your ad choices. Visit megaphone.fm/adchoices

Exercise is a stressor on your body.   If you can properly RECOVER from it, then it becomes a positive stressor that you adapt and grow stronger and more fit from.   But if you're not eating enough calories and macronutrients CONSISTENTLY THROUGHOUT THE DAY AND WEEK, as I'd venture to say ✨most women aren't✨, that high intensity exercise can turn into a negative stressor that breaks your body down.   Systems like reproduction can shut down to conserve energy.   In this episode I break down the 4 main recovery variables that, when out of whack, can cause high intensity training to mess with your hormones as a woman.   I also discuss what a “healthy” amount of exercise generally looks like for a woman who wants to be functionally fit for a long, healthy life.   Enjoy!   Click here to learn more about my group program Normal Eater: bit.ly/normaleaterdetails   Email me at elena@elenakunicki.com DM me on Instagram @elenakunickird      Resources for this episode:   8 week HIIT protocol improved PCOS outcomes:   https://pubmed.ncbi.nlm.nih.gov/36978202/#:~:text=Background%3A%20Studies%20have%20revealed%20that,of%20training%20for%20these%20women.   HIIT leads to reduced testosterone and increased estrogen in young women:  chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.researchgate.net/publication/361018368_High-Intensity_Interval_Training_leads_to_reduced_testosterone_and_increased_estrogen_levels_in_young_women/fulltext/64f519b1827074313ff7ff7c/High-Intensity-Interval-Training-leads-to-reduced-testosterone-and-increased-estrogen-levels-in-young-women.pdf   Exercise guidelines:    https://www.ama-assn.org/delivering-care/public-health/massive-study-uncovers-how-much-exercise-needed-live-longer#:~:text=Combine%20levels%20for%20best%20results,-%E2%80%9CA%20substantially%20lower&text=The%20study%20notes%20that%20%E2%80%9Cany,about%2035%25%20to%2042%25.   https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.121.058162   10,000 steps per day recommendation:   https://jamanetwork.com/journals/jamaneurology/article-abstract/2795819   https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2796058   Blue Zones physical activity level:   chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://research.bond.edu.au/files/200782461/Blue_Zones.pdf   Alyssa Olenick podcast interviews: https://theproof.com/exercise-nutrition-and-recovery-for-women-alyssa-olenick-part-2/   Dr. Peter Attia: https://peterattiamd.com/

¡Hola a todos! Soy el Doctor Mau y en este video vamos a sumergirnos en el maravilloso mundo del café. ☕✨ Vamos a descubrir juntos los **beneficios**, las **cualidades nutricionales** y sí, también los **efectos adversos** de esta bebida tan popular. Prometo que será una charla divertida y llena de información balanceada. - Beneficios del café: ¿Sabías que el café puede mejorar tu rendimiento físico y mental? ¡Te contaré cómo! - Cualidades nutricionales: Desglosaremos qué contiene el café y cómo esos componentes pueden influir en tu salud. - Efectos adversos: No todo es color de rosa, así que también hablaremos de los posibles efectos negativos de consumir café en exceso. Si te gusta el contenido, no olvides suscribirte a mi canal Doctor Mau Informa y activar la campanita

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-382 Overview: Tune in as we discuss the AHA's newly validated risk calculator designed to assess the risk of developing cardiovascular disease and heart failure in certain patients. We review which risk factor variables were included in the development of this new tool and whether to consider incorporating it in your practice. Episode resource links: https://doi.org/10.1161/CIRCULATIONAHA.123.067626 The calculator: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-382 Overview: Tune in as we discuss the AHA's newly validated risk calculator designed to assess the risk of developing cardiovascular disease and heart failure in certain patients. We review which risk factor variables were included in the development of this new tool and whether to consider incorporating it in your practice. Episode resource links: https://doi.org/10.1161/CIRCULATIONAHA.123.067626 The calculator: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-380 Overview: This episode brings you a comparison of thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers on cardiovascular outcomes, stroke, and all-cause mortality. Gain evidence-based insights to help you make informed choices for your patients' care. Episode resource links: Circulation . 2024 Jan 23;149(4):279-289. doi: 10.1161/CIRCULATIONAHA.123.066485. Guest: Jillian Joseph, MPAS, PA-C   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-380 Overview: This episode brings you a comparison of thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers on cardiovascular outcomes, stroke, and all-cause mortality. Gain evidence-based insights to help you make informed choices for your patients' care. Episode resource links: Circulation . 2024 Jan 23;149(4):279-289. doi: 10.1161/CIRCULATIONAHA.123.066485. Guest: Jillian Joseph, MPAS, PA-C   Music Credit: Richard Onorato

Inclisiran, sodium-channel blocker safety, analytic flexibility, the work-up of patients with HF, and BP in older patients are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Inclisiran Update ORION 4 https://classic.clinicaltrials.gov/ct2/show/NCT03705234 II. Sodium-Channel AADs UPenn Paper https://doi.org/10.1016/j.jacep.2024.01.021 Three Questions Editorial https://www.ahajournals.org/doi/full/10.1161/circoutcomes.110.957381 EAST Post-hoc Review https://doi.org/10.1093/europace/euae121 III. Analytic Flexibility   Is Red Meat Healthy? Multiverse Analysis Has Lessons Beyond Meat https://www.medscape.com/viewarticle/red-meat-healthy-multiverse-analysis-has-lessons-beyond-meat-2024a10008qv Specification Curve Analysis of Red Meat Data https://doi.org/10.1016/j.jclinepi.2024.111278 IV. The Work-up of Patients With HF Durstenfeld and colleagues, UCSF https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010800 REVIVED BCIS2 https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 V. BP Therapy in Older Patients Haring and colleagues; Women's Health  Initiative BP Study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067302 SPRINT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1511939 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The DEDICATE trial of TAVR vs SAVR, more on renal denervation, inclisiran, and marketing disguised as science are the topics John Mandrola, MD, discusses in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. TAVR vs SAVR TAVI Comparable With SAVR in Lower-Risk Aortic Stenosis https://www.medscape.com/viewarticle/tavi-comparable-savr-lower-risk-aortic-stenosis-2024a100074o?form=fpf DEDICATE https://www.nejm.org/doi/full/10.1056/NEJMoa2400685 Partner 3 https://www.nejm.org/doi/full/10.1056/NEJMoa1814052 Evolut Low Risk https://www.nejm.org/doi/full/10.1056/NEJMoa1816885 Barili meta-analysis https://doi.org/10.1093/ejcts/ezab516 II. Renal Denervation Alcohol-Mediated Renal Denervation Promising in Hypertension https://www.medscape.com/viewarticle/alcohol-mediated-renal-denervation-promising-hypertension-2024a10007eg TARGET 1 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069291 III. Inclisiran Earlier Inclisiran Gives Better Long-Term LDL Reductions https://www.medscape.com/viewarticle/earlier-inclisiran-gives-better-long-term-ldl-reductions-2024a10007d6 VICTORIAN INITIATE Trial https://www.jacc.org/doi/10.1016/j.jacc.2024.03.382 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington  Questions or feedback, please contact news@medscape.net

Bret Swanson put together an excellent slide deck to accompany this podcast, find it here: https://www.dropbox.com/scl/fi/5vaooui2r15zayv1kl2ye/2024-3-23-Dan-Wilson-Response-Slide-Deck.pdf?rlkey=3t5uizv3e0gep2q3vydouwtl7&dl=0*****Find Bret Swanson on X: @JBSay (https://twitter.com/JBSay)Find Bret Swanson on Substack: http://infonomena.substack.com/Find Joomi Kim on X: @JoomiKim1 (https://twitter.com/JoomiKim1)Find Joomi Kim on Substack: https://joomi.substack.com/*****PaleoValley: Wide array of amazing products, including SuperFood Golden Milk and beef sticks. Go to https://paleovalley.com/darkhorse for 15% off your first order.*****--Shared Sources --Krauson Et Al. https://www.nature.com/articles/s41541-023-00742-7 Roltgen Et Al. https://www.cell.com/cell/fulltext/S0092-8674(22)00076-9--Joomi Kim's Sources-- Nunez Castilla Et Al. https://www.mdpi.com/1999-4915/14/7/1415Can Li Et Al. https://academic.oup.com/cid/article/74/11/1933/6353927Buergin Et Al. https://pubmed.ncbi.nlm.nih.gov/37470105/Mansanguan Et Al. https://www.mdpi.com/2414-6366/7/8/196Shenton Et Al. https://www.sciencedirect.com/science/article/abs/pii/S0264410X23015165Yu Et Al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10373639/Mulligan Et Al. https://www.nature.com/articles/s41586-020-2639-4Cheng-Che Chen Et Al. https://onlinelibrary.wiley.com/doi/abs/10.1111/1756-185X.14482Jing-Xing Li Et Al. https://www.nature.com/articles/s41541-023-00661-7--Bret Swanson's Sources--Nakamura Et Al. https://www.mdpi.com/2076-393X/11/5/934Zaiem Et Al. https://www.sciencedirect.com/science/article/abs/pii/S0040595723001099Sharabi Et Al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575550/Guo Et Al. https://www.sciencedirect.com/science/article/pii/S1568997223000745Yonker Et Al. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.122.061025 Baumeier Et Al. https://www.mdpi.com/1422-0067/23/13/6940?cmid=de3a70dd-30e4-4d19-beef-1cf840d2ee7aSchwab Et Al. https://link.springer.com/article/10.1007/s00392-022-02129-5Joy Et Al. https://www.jacc.org/doi/abs/10.1016/j.jcmg.2021.04.011Tuvali Et Al. https://www.mdpi.com/2077-0383/11/8/2219/htm?mibextid=ykz3hlKarlstad Et Al. https://jamanetwork.com/journals/jamacardiology/article-abstract/2791253 Fauci https://www.cell.com/cell-host-microbe/pdf/S1931-3128(22)00572-8.pdfShrestha (Cleveland Clinic) https://academic.oup.com/ofid/article/10/6/ofad209/7131292McGreevy Et Al. https://academic.oup.com/jamiaopen/article/6/2/ooad026/7117831Deb Conrad: https://infonomena.substack.com/p/dr-hotezs-data-is-highly-flawedBrogna Et Al. https://onlinelibrary.wiley.com/doi/10.1002/prca.202300048 Jingan Chen Et Al. https://pnas.org/doi/10.1073/pnas.2309472120 Bitounis Et Al. https://www.nature.com/articles/s41573-023-00859-3Weissman (Parhiz Et Al.) https://www.cell.com/cell/fulltext/S0092-8674(22)00076-9Morz Et Al. https://www.mdpi.com/2076-393X/10/10/1651Arne Burkhardt: https://rumble.com/v2jbj16-arne-burkhardt-presentation-to-the-ccca.htmlAge Stratified Excess Mortality: https://infonomena.substack.com/p/society-of-actuaries-shows-continued Hoshino Et Al. https://pubmed.ncbi.nlm.nih.gov/35812802/ --Other Sources--Our world in data graph: https://ourworldindata.org/grapher/united-states-rates-of-covid-19-deaths-by-vaccination-statusArmada Et Al. https://www.science.org/doi/full/10.1126/sciimmunol.adh3455Norman Fenton “Cheap Trick” Statistical Games: https://wherearethenumbers.substack.com/pSupport the show

The Western AF meeting, aspirin, cannabis use, LVEF in athletes, and shared decision making before ICD implantation are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. ASA in Primary Prevention Campbell Meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065420 Swedish Observational study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.028321 ASPREE https://www.nejm.org/doi/full/10.1056/NEJMoa1805819 II. Cannabis Cannabis Use Tied to Increased Cardiovascular Risk https://www.medscape.com/viewarticle/cannabis-use-tied-increased-cardiovascular-risk-2024a10003yr It Sure Looks Like Cannabis Is Bad for the Heart, Doesn't It? https://www.medscape.com/viewarticle/1000250 Journal of the AHA Observational Study https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030178 III. Low EF in Athletes Reduced Ejection Fraction in Elite Endurance Athletes: Clinical and Genetic Overlap With Dilated Cardiomyopathy https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.063777 IV. ICDs and Shared Decision-Making Association of a Medicare Mandate for Shared Decision-Making With Cardiac Device Utilization https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2815017 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Contributor: Taylor Lynch MD Educational Pearls Hypothermia is defined as a core body temperature less than 35 degrees Celsius or less than 95 degrees Fahrenheit  Mild Hypothermia: 32-35 degrees Celsius Presentation: alert, shivering, tachycardic, and cold diuresis Management: Passive rewarming i.e. remove wet clothing and cover the patient with blankets or other insulation Moderate Hypothermia: 28-32 degrees Celsius Presentation: Drowsiness, lack of shivering, bradycardia, hypotension Management: Active external rewarming Severe Hypothermia: 24-28 degrees Celsius Presentation: Heart block, cardiogenic shock, no shivering Management: Active external and internal rewarming Less than 24 degrees Celsius Presentation: Pulseless, ventricular arrhythmia Active External Rewarming Warm fluids are insufficient for warming due to a minimal temperature difference (warmed fluids are maintained at 40 degrees vs. a patient at 30 degrees is not a large enough thermodynamic difference) External: Bear hugger, warm blankets Active Internal Rewarming Thoracic lavage (preferably on the patient's right side) Place 2 chest tubes (anteriorly and posteriorly); infuse warm IVF anteriorly and hook up the posterior tube to a Pleur-evac Warms the patient 3-6 Celsius per hour Bladder lavage Continuous bladder irrigation with 3-way foley or 300 cc warm fluid Less effective than thoracic lavage due to less surface area Pulseless patients ACLS does not work until patients are rewarmed to 30 degrees High-quality CPR until 30 degrees (longest CPR in a hypothermic patient was 6 hours and 30 minutes) Give epinephrine once you reach 35 degrees, spaced out every 6 minutes ECMO is the best way to warm these patients up (10 degrees per hour) Pronouncing death must occur at 32 degrees or must have potassium > 12 References 1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 1: Introduction. Circulation. 2005;112(24 SUPPL.). doi:10.1161/CIRCULATIONAHA.105.166550 2. Brown DJA, Burgger H, Boyd J, Paal P. Accidental Hypothermia. N Engl J Med. 2012;367:1930-1938. doi:10.1136/bmj.2.5543.51-c 3. Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness Environ Med. 2019;30(4S):S47-S69. doi:10.1016/j.wem.2019.10.002 4. Kjærgaard B, Bach P. Warming of patients with accidental hypothermia using warm water pleural lavage. Resuscitation. 2006;68(2):203-207. doi:10.1016/j.resuscitation.2005.06.019 5. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219. doi:10.1016/j.resuscitation.2021.02.011 6. Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest - Report of a case and review of the literature. Resuscitation. 2005;66(1):99-104. doi:10.1016/j.resuscitation.2004.12.024 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII  

Listener feedback on antiplatelet therapy after PCI, bempedoic acid, off-Label PFO Closure, and palliative care are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Listener Feedback on Antiplatelet Therapy After PCI Long-term Clopidogrel Has Advantages After Coronary Stenting https://www.medscape.com/viewarticle/long-term-clopidogrel-has-advantages-after-coronary-stenting-2024a10000c8 Host Exam Study;  Extended FU of Host-Exam https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062770 II. Bempedoic Acid This Week in Cardiology July 7, 2023 https://www.medscape.com/viewarticle/994089 NEJM: Bempedoic Acid and CV Outcomes JAMA: Primary Prevention Analysis https://jamanetwork.com/journals/jama/fullarticle/2806646 JAMA-Cardiology: Total Events Analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2813647/ III. Off-Label PFO Closure Circulation Outcomes Paperhttps://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010200 IV. Palliative Care JAMA: Palliative Care Consultation You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

GLP-1s and BaroStim Neo revisited, a new drug for transthyretin amyloid CM, clopidogrel vs ASA years after PCI and stent, and statins are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. GLP-1s and Obesity, BaroStim Neo Revisited FDA Expands Label for CVRx Barostim System in HF https://www.medscape.com/viewarticle/fda-expands-label-cvrx-barostim-system-hf-2023a1000wsx JAMA Cardiology Special Communication – BDP https://jamanetwork.com/journals/jamacardiology/fullarticle/2810726 II. ATTR Cardiomyopathy ATTRibute-CM NEJM paper https://www.nejm.org/doi/full/10.1056/NEJMoa2305434 Circulation Review of TTR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.111.078915 ATTR-ACT (Tafadimis) https://www.nejm.org/doi/10.1056/NEJMoa1805689 III. Clopidogrel vs ASA Years After PCI Long-term Clopidogrel Has Advantages After Coronary Stenting https://www.medscape.com/viewarticle/long-term-clopidogrel-has-advantages-after-coronary-stenting-2024a10000c8 Stop DAPT Original Trial STOP DAPT at 5 Years https://doi.org/10.1016/j.jacc.2023.10.013 Network Meta-analysis of P2Y12-I vs ASA https://doi.org/10.1016/j.jcin.2022.08.009 IV. Statin Use Statin Use Remains Low for At-Risk Patients https://www.medscape.com/viewarticle/999043 Annals of Internal Medicine Observational Study https://doi.org/10.7326/M23-1915 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

FDA approves PFA, breakthrough in PAH, residual leaks after percutaneous LAAO, OAC in low to intermediate risk people are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. FDA Approves PFA FDA Approves First Pulsed Field Ablation System for AF https://www.medscape.com/viewarticle/fda-approves-first-pulsed-field-ablation-system-af-2023a1000vit - PULSED AF https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064329 - ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 - MANIFEST https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064959 II. Pulmonary HTN Positive Topline Data for Sotatercept in PAH: STELLAR https://www.medscape.com/viewarticle/982407 - STELLAR https://www.nejm.org/doi/10.1056/NEJMoa2213558 - Editorial on STELLAR https://www.nejm.org/doi/full/10.1056/NEJMe2300324 III. Peri-Device Leaks - Greek Meta-analysis https://doi.org/10.1093/eurheartj/ehad828 IV. Intermediate Risk AF – Norwegian Study - Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one: the Norwegian AFNOR study AFNOR Study https://doi.org/10.1093/eurheartj/ehad659 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Contact Dr.Gandhi and Shore Smiles Dental (516)321-4717 https://www.shoresmilesdentalny.com/biological-dentistry https://toothandbody.com - to explore the interactive meridian pathway Join our FREE 3 Day Water Fast: https://fast.garybrecka.com/go-1 Get weekly tips from Gary Brecka on how to optimize your health and lifestyle routines - go to https://www.theultimatehuman.com/ For more info on Gary, please click here: ⁠⁠https://link.me/garybrecka [link.me]⁠⁠ Order The 1 Genetic Test That Will Give You Results For Life Here: ⁠⁠⁠https://10xhealthnetwork.com/pages/genetic-testing?utm_source=gbrecka⁠⁠ Get The Supplements That Gary Recommends Here: ⁠⁠⁠⁠⁠⁠⁠https://10xhealthnetwork.com/pages/supplements?utm_source=gbrecka Sign up for 10X Health Affiliate Program https://10xhealthsystem.com/GBaffiliate ECHO GO PLUS HYDROGEN WATER BOTTLE https://echoh2o.com/?oid=19&affid=236 BODY HEALTH - USE CODE ULTIMATE10 for 10% OFF YOUR ORDER https://bodyhealth.com/ultimate Today's conversation will change your life, and could possibly even save your life. Gary and his wife Sage traveled to Long Island to interview their friend and amazing biologic dentist, Dr. Jigar Gandhi.  So many people chalk up dental and health issues to aging when that just simply isn't the case. Listen in as we educate about the link between periodontal disease, inflammation, gum disease, and all kinds of cardiovascular disease and neurodegenerative disorders. Gary and Dr. Gandhi talk about how the same bacteria that is found in gums and the jaw bone are found in the heart through the blood supply. As someone who is very woke to wellness himself, Gary shares his experience of getting dental work done with Dr. Gandhi and how he had no idea that issues going on in his mouth could be connected to symptoms in other parts of his body. Dr. Gandhi was able to pinpoint specific pain and issues in Gary's left shoulder, lung, and toe that were linked to a tooth that needed to be removed.  01:45 Biological dentistry and its connection to overall health.  07:30 Gary's dental issue that was causing symptoms in other parts of the body. 10:00 How is dental work linked to neurodegenerative disorders? 16:15 The importance of proper blood flow for dental procedures. 19:00 Finding the mystery cause of the issues Sage's sister was having with her kidneys. 22:00 What inspired you to get into Biologic Dentistry? 24:15 The link between dental bacteria to metabolic syndrome. 26:15 What causes bacteria and parasites to pool in the jawline? 32:30 How to detect if you have bacteria and parasites in your jaw from previous dental work. 34:15 What does it mean if a tooth is black? 40:30 Fluoride and its potential effects on health.  43:40 Are “soft teeth” hereditary? 46:00 What is the pain level and healing like from getting biologic dentistry work done? 50:00 Oral health and detoxification.  Journal Articles Referenced https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097266/ https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.106.685230 https://pubmed.ncbi.nlm.nih.gov/34579810/ https://pubmed.ncbi.nlm.nih.gov/36726625/ https://www.mdpi.com/2076-2607/11/7/1832 Follow Dr. Gandhi: @smilesbydrg Gary Brecka: @garybrecka The Ultimate Human: @ultimatehumanpod Subscribe on YouTube: @ultimatehumanpodcast Disclaimer: The Ultimate Human with Gary Brecka Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions. Learn more about your ad choices. Visit megaphone.fm/adchoices